SUMMARY

The World Health Orginazation that on average, 700,000 individuals die yearly to suicide. It is also reported that suicide and self-harm is one of the leading causes of death, especially in the younger population, 15–29-year-olds. Suicide can be caused by extreme moments of stress and can be exasperated by other mental disorders such as depression. There is a clear expectation of dying. The most substantial risk factor includes previous suicide attempt/s and self-harm behaviors. Suicide is a public health problem in all countries and affects all income levels. Men within a high-income socioeconomic status demographic are three times more likely to commit suicide than low- and middle-income countries where the ratio is more balanced. Vulnerable groups who experience discrimination, such as LGBTI persons, migrants, and prisoners, are more susceptible to suicide attempts.

Self-harm is the deliberate self-infliction of damage to body tissue; this can include suicidal intent or not. Self-harm usually does not refer to eating disorders or substance abuse. Instead, it has been used to describe how people deal with painful memories, overwhelming situations, and complicated feelings. While there is an emotional release after self-harming, this does not cure the cause of distress and sometimes makes you feel worse. In addition, it carries many risks and can be hard to stop once started.

Epidemiological information on suicide and self-harm rates is scarce in the Middle East, and there is a need to gather more data to see future changes. Although, WHO recognizes the need to make suicide prevention a priority, all countries must develop suicide prevention programs into their educational programs for a sustainable reduction in suicide rates.

Types

Active suicidal ideation: Having a plan on how to commit suicide to follow through
Passive suicidal ideation: No plans on actually committing suicide but wishing you could die or were dead.

Suicidal ideation can be a symptom of other disorders such as major depression, but it also may occur in people with no mental illnesses at all. There are a variety of common suicide methods, such as hanging and firearms or self-poisoning. Passive suicidal ideation can quickly turn into action; it should be considered equally as dangerous as situations can trigger it.

There are many different kinds of self-harm which can include but is not limited to:

Cutting skin
Burning skin
Hitting/ banging head

These behaviors are usually demonstrated in more than one way when expressed as non-suicidal self-injury, but this can also extend to suicide intent.

Causes

There are many factors when people consider suicide and idealize it. These can include some of the following:

Feeling hopeless, isolated, and/or lonely
Having other mental health disorders (depression, bipolar, PTSD and anxiety)
Being part of the LGTBI community
Having a chronic physical illness like cancer, diabetes, or a terminal disease
Not being married
Having chronic pain
Having a family history of suicide
Having a drug or alcohol use disorder
Having experienced childhood abuse or trauma
Having access to firearms
Failed relationships
Medical illnessFamily history

While many of the negative feelings with suicide and self-harm can be expected, self-injury is a way to have control or cope with these emotions and is generally not considered a suicide attempt. These cycles can, however, get out of control and become quite destructive.

When a person engages in self-harm behavior, they are usually trying to:

Deal with an interpersonal problem
Relief from a negative state of mind or feeling
Feel a positive state

Symptoms

There are warning signs when you or a loved one contemplates suicide. This can look different for everyone. Some examples include:

Talking about death or suicide
Isolating yourself from your loved ones
An increase in substance use or misuse
Feeling hopeless or trapped
Increased mood swings, anger, rage, and/or irritability
Acting as if you're saying goodbye to people
The individual has made a suicide attempt within the past two years.

Signs of self-harm include:

Fully covered clothes even in hot weather
Cuts, burns, or bruises without explanation usually in wrists and thighs
Signs of depression
Signs of low self-esteem, such as thinking they are not good enough

Diagnosis

If you are experiencing suicidal or self-harm thoughts, a diagnosis is required by a medical professional. It is essential to first rule out any physical conditions before concluding it is a mental health condition. The health care professional is the only one who can diagnose/ treat any mental health condition.

For suicide, they will take a full history and ask if there are risk factors such as drug or alcohol abuse, as well as medication use. To get a full diagnose it is important to know how long these thoughts have been present and if you or your loved one has a plan to commit suicide.

The DSM lists many comorbid conditions that could lead or result in suicidal behaviors. Having one of more of these has been known to increase the risk but it is also not necessary. These conditions include:

Eating disorders eg. Anorexia Nervosa
Bipolar Disorder
Borderline Personality Disorder
Major depressive disorder
Post-traumatic stress disorder
Schizophrenia
Social anxiety

With self-harm, the intentional damage caused by self-infliction to the surface of the body, without suicidal intent for 5 or more days within the past year. Before they require self-injurious behavior, the person usually experiences frequent urges and difficult feelings/thoughts.

Treatment

A number of treatment options are given if you have suicidal thoughts but are not in immediate danger. Some of these can include:

Psychotherapy: working with a therapist to identify the cause of the suicidal feelings and manage them. This can include involving family, so they are aware and help to better understand their family member’s situation. When there is a high risk of a suicide attempt, it might be necessary that there is a higher level of care, such as hospitalization or intense outpatient therapy. It is important for an individual to go seek consistent therapy. A person who continues treatment after passing a crisis will be able to explore prevention methods towards suicidal ideation, and self-harm as long as they are consistent of their coping strategies.

Medications: this can treat the underlying cause, such as depression. Some of these medications can include anti-depressants, anti-anxiety, and anti-psychotic medication.

Anti-depressants: a type of medication that helps relieve symptoms of depression, anxiety, and other conditions. The goal is to correct any chemical imbalances in the brain responsible for mood and mood regulation. Different classes of medications work differently in the brain. Some work better than others depending on the individual, their age, their reaction to the medication, and what medications are available to them. As with all kinds of medications, side effects exist for all types of antidepressants and must be discussed with their mental health care provider to mitigate these side effects. Antidepressants also carry the risk of abuse and addiction if they are mishandled.

Anti-anxiety: a type of medication that helps relieve the symptoms of acute anxiety, such as panic attacks. These medications for immediate relief include benzodiazepines. As with all kinds of medication, there are side effects such as drowsiness, irritability, memory, and attention problems. They also carry the risk of physical dependency or abuse. Another type of medication is Buspirone which has fewer side effects and physical dependence but may not be as effective as the benzodiazepines.

Anti-psychotics: this is more focused when the underlying cause is psychiatric disorders such as schizophrenia or bipolar disorder

Lifestyle Changes: improving sleep, eating and exercise habits, managing stress, and having a support network. Finding a reason for hope is essential; instead of engaging in self-destructive behavior, an individual needs to work through positive behaviors.

Resources

Many resources are available, such as crisis centers, health care professionals, family, friends, and colleagues. If you are looking to help a suicidal person, be aware of their needs and permission in seeking help. Prevention can also include limiting access to the methods of suicide and early identification and management. The WHO endorses World Suicide Prevention Day and focuses on the need for action to address the issues. They have published resources aimed to reduce the global suicide rate as well as educate the media in responsible reporting when referencing suicide.
While there is an overlap between self-injury and suicide, it is a complicated relationship. Most people do not intend to commit suicide when they have non-suicidal self-harm, but it could have gotten out of control or become addicted to the behaviour, which can lead to suicide attempts.
If you feel like you or someone you know may be experiencing symptoms of suicide or self-harm thoughts, please seek help from a qualified health care professional, family member, or friend. Suicide is preventable. Reach out for help; you are not alone.